EFFECTS OF EARLY PROPRIOCEPTIVE NEUROMUSCULAR FACILITATION EXERCISES ON SENSORY- MOTOR RECOVERY OF UPPER EXTREMITY AND NEUROPLASTICITY IN THE PATIENTS WITH ACUTE STROKE
Abstract
Background: After a stroke, 80% of patients experience acute paresis of the upper extremity. Proprioceptive neuromuscular facilitation (PNF) is a widely used rehabilitation concept, but many studies do not discuss its utility as a rehabilitative tool in acute stroke. The main objective of this study was to investigate the effects of early PNF exercises on the sensory-motor recovery of upper extremity and neuroplasticity in the patients with acute stroke.
Methods: Total 90 patients were enrolled and divided randomly into two groups, Group A (n= 41), - received PNF exercises and group B (n= 49), - received traditional exercises. Patients in group A were given PNF exercises for trunk, scapula and upper extremity 30 minutes twice daily, five days a week for four weeks and patients in group B were given traditional exercises for the same duration. Fugl- Meyer Scale was assessed for sensory-motor recovery and Arm Motor Ability test scores were assessed for functional activities of the upper extremity. To look for its effects on neuroplasticity, serum BDNF levels were assessed before and after the intervention.
Results: Group A showed more improvement than group B in motor scores (Upper Extremity portion of the Fugl- Meyer assessment, p =0.017) and functional activities of the upper extremity (AMAT, p=0.038). The sensory improvement was more in group A. There was no significant difference in pain and range of motion scores. No deformity and any adverse event noted in both groups after intervention. Serum BDNF levels showed better scores in Group A.
Conclusions: PNF exercises are efficient to improve the upper extremity function in acute stroke. Early implementation of PNF exercises promotes neuroplasticity in a better way.
Downloads
References
hemiparetic arm after stroke. Journal of rehabilitation research and development 2006;43:171-84.
[2] Masiero S, Celia A, Rosati G, Armani M. Robotic-assisted rehabilitation of the upper limb after acute stroke. Archives of physical medicine and rehabilitation
2007;88:142-9.
[3] Feys HM, De Weerdt WJ, Selz BE, Cox Steck GA, Spichiger R, Vereeck LE, et al. Effect of a therapeutic intervention for the hemiplegic upper limb in the acute phase after stroke: a single-blind, randomized, controlled multicenter trial. Stroke 1998;29:785-92.
[4] Kwakkel G, Kollen BJ, van der Grond J, Prevo AJ. The probability of regaining dexterity in the flaccid upper limb: impact of severity of paresis and time since onset in acute stroke. Stroke 2003;34:2181-6.
[5] Lum PS, Mulroy S, Amdur RL, Requejo P, Prilutsky BI, Dromerick AW. Gains in upper extremity function after stroke via recovery or compensation: Potential differential effects on the amount of realworld limb use. Topics in stroke rehabilitation 2009;16:237-53.
[6] Kim EK, Lee DK, Kim YM. Effects of aquatic PNF lower extremity patterns on balance and ADL of stroke patients. Journal of physical therapy science 2015;27:213-5.
[7] Hwangbo PN, Don Kim K. Effects of proprioceptive neuromuscular facilitation neck pattern exercise on the ability to control the trunk and maintain balance in chronic stroke patients. Journal of physical therapy science 2016;28:850-3.
[8] Wang JS, Lee SB, Moon SH. The immediate effect of PNF pattern on muscle tone and muscle stiffness in a chronic stroke patient. Journal of physical therapy science 2016;28:967-70.
[9] Singh G. Determination of cutoff scores for a Diagnostic Test. Internet Journal of Laboratory Medicine 2006;2:1-4.
[10] Verheyden G, Nuyens G, Nieuwboer A, Van Asch P, Ketelaer P, De Weerdt W. Reliability and validity of trunk assessment for people with multiple sclerosis. Physical therapy 2006;86:66-76.
[11] Mang CS, Campbell KL, Ross CJ, et al. Promoting neuroplasticity for motor rehabilitation after stroke: considering the effects of aerobic exercise and genetic variation on the brain-derived neurotrophic factor. Phys Ther. 2013;93(12):1707–1716.
[12] Kabat H. Central facilitation; the basis of treatment for paralysis. Perm Found Med Bull. 1952;10(1-4):190–204.
[13] Kabat H. Studies on neuromuscular dysfunction. XV. The role of central facilitation in the restoration of motor function in paralysis. Arch Phys Med. 1952;33(9):521–533.
[14] Irwin OC. Proximodistal differentiation of limbs in young organisms. Psychological Review. 1933;40(5):467– 477.
[15] McGraw MB. Grasping in infants and the proximo-distal course of growth. Psychological Review. 1933;40(3):301–302.
[16] Sherrington C. The integrative action of the nervous system. USA: New Haven Yale University Press; 1920.
[17] Voss DE. Proprioceptive neuromuscular facilitation. Am J Phys Med. 1967;46(1):838–899.
[18] Kurozumi K, Nakamura K, Tamiya T, et al. BDNF gene-modified mesenchymal stem cells promote functional recovery and reduce infarct size in the rat middle cerebral artery occlusion model. Mol Ther. 2004;9(2):189–197.
[19] Schabitz WR, Steigleder T, CooperKuhn CM, et al. Intravenous brainderived neurotrophic factor enhances poststroke sensorimotor recovery and stimulates neurogenesis. Stroke. 2007;38(7):2165–2672.
[20] Ploughman M, Windle V, MacLellan CL, et al. Brain-derived neurotrophic factor contributes to the recovery of skilled reaching after focal ischemia in rats. Stroke. 2009;40(4):1490–1495.
[21] Stanne TM, Åberg ND, Nilsson S, et al. Low circulating acute brainderived neurotrophic factor levels are associated with poor long-term functional outcome
after ischemic stroke. Stroke. 2016;47(7):1943– 1945.
[22] Griffin ÉW, Mullally S, Foley C, et al. Aerobic exercise improves hippocampal function and increases BDNF in the serum of young adult males. Physiol Behav. 2011;104(5):934–941.
[23] Kitamura J, Nakagawa H. Visual influence on contact pressure of hemiplegic patients through the photoelastic sole image. Arch Phys Med Rehabil. 1996;77(1):14–18.
[24] Richard A Schmidt, Lee TD. Motor control and learning: a behavioral emphasis. Champaign, IL, US: Human Kinetics; 2005:537.
[25] Warraich Z, Kleim JA. Neural plasticity: the biological substrate for neurorehabilitation. PM & R. 2010;2(12Suppl 2): S208–219.
[26] Rodier M, Quirié A, Prigent-Tessier A, Béjot Y, Jacquin A, Mossiat C, Marie C, Garnier P. Relevance of post-stroke circulating BDNF levels as a prognostic biomarker of stroke outcome. Impact of rt-PA treatment. PloS one. 2015 Oct 15;10(10):e0140668.
[27] Lasek-Bal A, Jędrzejowska-Szypułka H, Różycka J, Bal W, Holecki M, Duława J, Lewin-Kowalik J. Low concentration of BDNF in the acute phase of ischemic stroke as a factor in poor prognosis in terms of the functional status of patients. Medical science monitor: international medical journal of experimental and clinical research. 2015;21:3900.
